Evaluation of a Food Retail Shelf-Label Program to Increase Healthful Purchases: a Cluster Randomized Control Trial Utilizing the RE-AIM Framework

Food retail interventions promoting healthy food choice, such as shelf-label programs, provide an innovative opportunity for Registered Dietitian Nutritionists to positively influence consumer purchases. This study was a cluster-randomized control trial evaluating a dietitian-branded (“Dietitian’s Pick”) shelf-label program compared to a healthy-branded (“Healthy Pick”) program, compared to a control group, implemented at 124 grocery retail stores. The RE-AIM framework guided program evaluation which included a process evaluation, primarily focused on fidelity assessment and utilizing quantitative and qualitative methods, and an outcome evaluation assessing aggregate monthly lift of sales and units sold of promoted products in a repeated measures mixed effects ANOVA. A sub-category analysis was also conducted to compare lift of labeled products to unlabeled products and an Electronic Customer Survey assessed exposure to, use of, and satisfaction with the program. Results revealed that the shelf-label program was implemented with high fidelity, which increased statistically significantly over time [F(3, 153.87) = 20.40, p p < .001; “Healthy Pick”: 5.91% (95% CI [3.53,8.30]), p < .001] and units sold [“Dietitian’s Pick”: 6.08% (95% CI [3.63,8.53]), p < .001; “Healthy Pick”: 5.06% (95% CI [2.58,7.54]), p < .001] during one month of the evaluation (December) compared to control. The subcategory analysis indicated lift of labeled products increased statistically significantly more than unlabeled products for the treatment conditions, but not for control. Customers (77.45%, n=158) reported exposure to at least one version of the shelf-label program and the majority were at least “somewhat satisfied” with the “Dietitian’s Pick” (76.19%, n=16) and “Healthy Pick” (83.05%, n=49) program. More customers reported preference for “Healthy Pick” (85.55%, n=159) over “Dietitian’s Pick” (14.52%, n=27) branding. Results suggest shelf-label programs may increase sales of healthier foods, especially during certain time periods. Additional research is needed to determine how timing and seasonality of implementation as well as branding of shelf-label programs impact outcomes.